I’d work very hard, but I’m lazy

I like my job well enough, most of the time, but trekking into the office every morning is a bit of a drag, so I’m always on the lookout for new developments in the field of telepsychiatry, in the hope that one day I’ll be able to practice from the comfort of my couch.

Back when I first got into Second Life I fondly imagined that a virtual world would provide the perfect location for remote consultation, but my actual experience of the grid quickly disabused me of that notion; for all its digital verisimilitude SL isn’t anything like face-to-face interaction. Of course it can be argued that this is actually an advantage, that freed from their corporeal baggage people can access aspects of their personalities that would otherwise remain obscured, thus deepening their self-knowledge. There is something in this, but such information would only be one part of the puzzle, and would have to be interpreted in the context of the whole of a client’s life. In general, people who seek therapy are struggling with concrete problems of everyday existence, and a therapist has to engage with them on that level, which means sitting down, looking them in the eye, and talking to them.

Even if one could find a way around this, there are a multitude of other, practical, problems with e-therapy; things like verifying identity and credentials, licensing and jurisdictional issues, difficulties with record-keeping and confidentiality, and crisis response. These can be overcome, but only if the client physically shows up at the office every so often. Virtual consultation can be a valuable part of a treatment package, but not the whole of it.

That’s been my settled opinion for years now, but I do keep reading the literature on the off-chance I’ll be proved wrong some day.

Clinicians routinely grumble that researchers are overly picky when recruiting subjects, which is usually unfair, because, you know, research is hard enough without having to deal with actual sick people. This study’s exclusion criteria seem particularly egregious though; participants not only had to be young and healthy, they had to be familiar with Second Life too. It’s hard to imagine a group less similar to the typical clinic population. Even with this promising start the intervention still managed to fail to show a significant improvement on three out of four of their outcome measures, and a clinically negligible change on the fourth one. In any case there was no control group, so it’s hard to credit the effects, or lack of them, to the treatment.

I’ve read enough of these reports, that sound promising but are ultimately underwhelming, that I should be immune to them by now, but I can’t help feeling disappointed. I guess I’ll be waking up and getting up for the foreseeable future.